Complete Revascularization vs Culprit Lesion–Only Percutaneous Coronary Intervention for Angina-Related Quality of Life in Patients With ST-Segment Elevation Myocardial Infarction
Authors: Shamir R. Mehta, Jia Wang, David A. Wood, John A. Spertus, David J. Cohen, Roxana Mehran, Robert F. Storey, Philippe Gabriel Steg, Natalia Pinilla-Echeverri, Tej Sheth, Kevin R. Bainey, Sripal Bangalore, Warren J. Cantor, David P. Faxon, Laurent J. Feldman, Sanjit S. Jolly, Vijay Kunadian, Shahar Lavi, Jose Lopez-Sendon, Mina Madan, Raul Moreno, Sunil V. Rao, Josep Rodés-Cabau, Goran Stanković, Shrikant I. Bangdiwala, John A. Cairns, John Amerena, Ahmad Farshid, Chris Zeitz, Stephen Duffy, Dion Stub, Melanie Freeman, Irene Lang, Suzanne Pourbaix, Antoine Guedes, Adrian Kormann, Paulo Caramori, José Carlos Nicolau, Márcio Santos, José Antonio Marin-Neto, José Francisco Kerr Saraiva, Jose de Ribamar Costa, Robert Welsh, Kapil Bhagirath, Saleem  A. Kassam, Anthony Della Siega, Vladimír Džavík, Robert Boone, Asim Cheema, Mouhieddin Traboulsi, Robert Teskey, Tycho Vuurmans, John Ducas, Eric Cohen, Michel Nguyen, Philippe Généreux, Erick Schampaert, Hahn Hoe Kim, Najaf Nadeem, André Kokis, Warren Ball, Payam Dehghani, Brian Wong, Bruce Sussex, Samer Mansour, Kushal Dighe, Jean-Philippe Pelletier, Yuan Wu, Xiao-Shu Cheng, Qingsheng Wang, Jia Shaobin, Ma Yitong, Yin Yuehui, Wei Wu, Qun Zheng, Qiang Fu, Boris Vesga, Ota Hlinomaz, Kari Niemelä, Olivier Varenne, Laurent Feldman, Olivier Dubreuil, Jean Guillaume Dillinger, Emile Ferrari, Olivier Nallet, Oliver Bruder, Georgios Hahalis, Antonios Ziakas, Vassilis Voudris, Zsolt Kőszegi, Ivan Horvath, Shmuel Fuchs, Michael Kapeliovich, Fabrizio D’Ascenzo, Giuseppe Di Pasquale, Vincenzo Guiducci, Gianluca Campo, Ferdinando Varbella, Darar Al khdair, Vytautas Abraitis, Sasko Kedev, Juan Carlos Perez Alva, Bogdan Janus, Artur Baszko, Hélder Pereira, Fausto Pinto, Maria Dorobantu, Khalid Alhabib, Mohammad Al Shehri, Mpiko Ntsekhe, Pravin Manga, José Ramón González Juanatey, Pablo Avanzas, Francisco Fernández Aviles, Andrés Iñiguez, Antonio Fernandez Ortiz, Fina Mauri, Iñigo Lozano, Ignacio Sánchez Pérez, Giovanna Sarno, Robert Kastberg, Florim Cuculi, Habib Haouala, Richard Oliver, Alisdair Ryding, Andrew Sutton, David Newby, Benjamin Wrigley, Sam Firoozi, Joanne Shannon, Michael Seddon, Neville Kukreja, Konrad Grosser, Joseph Mills, Ian Webb, Tim Wells, Robin van Lingen, Michael Ragosta, Peter Johnston, Sean Wilson, Stacey Clegg, Richard Bach, Donald Cutlip, Jason Call, John Lopez, Catalin Toma, Kevin Marzo, Paul Frey, Mark Menegus, Nabil Dib, Chao-Wei Hwang, Steven Laster, Ryan Reeves, Mamoo Nakamura, Salman Arain, Thomas Stuckey, Dhananjai Menzies
Journal: JAMA Cardiology (2022)

Importance In patients with multivessel coronary artery disease (CAD) presenting with ST-segment elevation myocardial infarction (STEMI), complete revascularization reduces major cardiovascular events compared with culprit lesion–only percutaneous coronary intervention (PCI). Whether complete revascularization also improves angina-related health status is unknown. Objective To determine whether complete revascularization improves angina status in patients with STEMI and multivessel CAD. Design, Setting, and Participants This secondary analysis of a randomized, multinational, open label trial of patient-reported outcomes took place in 140 primary PCI centers in 31 countries. Patients presenting with STEMI and multivessel CAD were randomized between February 1, 2013, and March 6, 2017. Analysis took place between July 2021 and December 2021. Interventions Following PCI of the culprit lesion, patients with STEMI and multivessel CAD were randomized to receive either complete revascularization with additional PCI of angiographically significant nonculprit lesions or to no further revascularization. Main Outcomes and Measures Seattle Angina Questionnaire Angina Frequency (SAQ-AF) score (range, 0 [daily angina] to 100 [no angina]) and the proportion of angina-free individuals by study end. Results Of 4041 patients, 2016 were randomized to complete revascularization and 2025 to culprit lesion–only PCI. The mean (SD) age of patients was 62 (10.7) years, and 3225 (80%) were male. The mean (SD) SAQ-AF score increased from 87.1 (17.8) points at baseline to 97.1 (9.7) points at a median follow-up of 3 years in the complete revascularization group (score change, 9.9 [95% CI, 9.0-10.8]; P &amp;amp;lt; .001) compared with an increase of 87.2 (18.4) to 96.3 (10.9) points (score change, 8.9 [95% CI, 8.0-9.8]; P &amp;amp;lt; .001) in the culprit lesion–only group (between-group difference, 0.97 points [95% CI, 0.27-1.67]; P = .006). Overall, 1457 patients (87.5%) were free of angina (SAQ-AF score, 100) in the complete revascularization group compared with 1376 patients (84.3%) in the culprit lesion–only group (absolute difference, 3.2% [95% CI, 0.7%-5.7%]; P = .01). This benefit was observed mainly in patients with nonculprit lesion stenosis severity of 80% or more (absolute difference, 4.7%; interaction P = .02). Conclusions and Relevance In patients with STEMI and multivessel CAD, complete revascularization resulted in a slightly greater proportion of patients being angina-free compared with a culprit lesion–only strategy. This modest incremental improvement in health status is in addition to the established benefit of complete revascularization in reducing cardiovascular events.